Remote AVP, Claims & Configuration Leader

Prime Therapeutics; Richmond (VA); Remote; USD 164,000 - 279,000; Full time

Job summary

Prime Therapeutics is seeking an Associate Vice President, Claims & Configuration, to lead strategic direction and performance of pharmacy claims adjudication and configuration operations. This remote role focuses on modernizing platforms, ensuring regulatory compliance, and delivering superior client outcomes.

The AVP will guide cross-functional teams, define roadmaps, monitor KPIs, and drive transformational initiatives across claims and configuration ecosystems while managing budget and

Qualifications

• Bachelor’s degree or higher in a related field; HS diploma from an accredited school or equivalent GED.
• At least 12 years in PBM, health plan, or healthcare operations with large-scale transformations.
• At least 8 years of leadership/people management experience.
• Eligibility to work in the United States without visa sponsorship.

Responsibilities

• Lead cross-functional teams in claims adjudication, benefit configuration, testing, and production support.
• Drive modernization and continuous improvement for operational efficiency and customer experience.
• Own strategy, roadmap, and governance for claims adjudication and configuration with regulatory alignment.
• Oversee interpretation and implementation of client benefit plans, formularies, and pricing rules within systems.
• Collaborate with partners to prioritize enhancements and deliver strategic business outcomes.
• Establish KPIs for accuracy, compliance, and service excellence; monitor financial metrics.
• Lead initiatives to reduce risk, improve speed-to-market, and address technical debt.
• Develop organizational capability through talent management and budget oversight.

Skills

Executive communication

Regulatory compliance understanding

Operational leadership

Strategic program management

Education

Bachelor's degree in Business, Health Care Administration, or related field

HS diploma or GED

Tools

Claims adjudication platforms

Benefit configuration systems

Job description

Prime Therapeutics is seeking an Associate Vice President, Claims & Configuration, to lead strategic direction and performance of pharmacy claims adjudication and configuration operations. This remote role focuses on modernizing platforms, ensuring regulatory compliance, and delivering superior client outcomes.

The AVP will guide cross-functional teams, define roadmaps, monitor KPIs, and drive transformational initiatives across claims and configuration ecosystems while managing budget and